Written Notification of Review

8.4.6.1.1 - Written Notification of Review (Rev. 906; Issued: 09-26-19; Effective: 01-02-19; Implementation: 01-02-19) The contractor shall include at least the following in the notification of review: • An explanation of why the review is being conducted (i.e., why the provider or supplier was selected), • The time period under review, • A list of claims that require medical records or other supporting documentation, • A statement of where the review will take place (provider/supplier office or contractor site), • Information on appeal rights, • An explanation of how the sampling results will be used to estimate the total overpayment if claims are denied upon review and an overpayment is determined to exist, and • An explanation of the possible methods of monetary recovery if an overpayment is determined to exist. When advance notification is given, providers and suppliers have 30 calendar days to submit (for contractor site reviews) or make available (for provider/supplier site reviews) the requested documentation. The contractor shall advise the provider or supplier that for requested documentation that is not submitted or made available by the end of 30 calendar days, the contractor will start the review and will deny those claims for which there is no documentation. The time limit for submission or production of requested documentation may be extended at the contractor’s discretion. NOTE: The contractor need not request all documentation at the time of notification of review; for example, the contractor may decide to request one-half of the documentation before the contractor arrives, and then request the other half following the contractor’s arrival at the provider/supplier’s site. When advance notification is not given, the contractor shall give the provider or supplier the written notification of review when the contractor arrives at their site.